The phrase “in deep kimchi” is a humorous expression in the US military slang meaning to be in serious trouble. Why am I in deep trouble you ask? Looking at one of my recent lab results, you may notice that my Albumin dropped from 3.6 to 3.1, a full 0.5. You may now further ask, so what? That’s what this blog is about.

The form of protein found in your blood is called albumin. You can think of albumin as your body’s mail carrier – it delivers nutrients, vitamins, minerals, and energy you get from food to the rest of your body. It also helps the fluid you drink to stay in your cells and blood vessels, and it helps fight infection. Dialysis removes some of the albumin in your blood which is why people on dialysis need to have a protein source at every meal and sometimes with snacks.

With this background, I asked several questions of Perplexity which are included in the following dialog. Read on for more info on this complex subject. The bottom line is that lower Albumin levels lead to a higher probability of death. Got your attention now?

In peritoneal dialysis (PD) patients, serum albumin levels below specific thresholds indicate increased mortality risk. A baseline serum albumin level below 3.0 g/dL is associated with a more than threefold higher risk of all-cause, cardiovascular, and infection-related mortality compared to levels between 4.00-4.19 g/dL[1]. Additionally, PD patients with serum albumin levels below 3.8 g/dL also face an increased mortality risk[1]. Maintaining serum albumin levels above these thresholds is crucial for reducing mortality risk in PD patients.

Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/21601335/
[2] https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-019-1433-8
[3] https://www.sciencedirect.com/science/article/abs/pii/S0272638611007293
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159826/
[5] https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.917603/full

To raise albumin levels in peritoneal dialysis patients, a diet rich in high-quality protein is essential. Recommended protein sources include lean meats like chicken and fish, eggs, and dairy products such as cottage cheese and Greek yogurt[1][4][5]. It’s important to avoid processed meats due to their high sodium and phosphorus content[1][4]. Additionally, incorporating protein-rich foods like tofu and protein supplements can be beneficial[4]. Consulting with a dietitian can help tailor a diet plan that meets individual needs while maintaining kidney health[1][5].

Citations:
[1] https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis/eating-nutrition
[2] https://www.jrnjournal.org/article/S1051-2276%2803%2900035-9/fulltext
[3] https://advancingdialysis.org/peritoneal-dialysis/nutritional-status-concerns-for-peritoneal-dialysis-patients/
[4] https://www.davita.com/diet-nutrition/articles/advice/15-kidney-friendly-protein-foods-for-keeping-albumin-up
[5] https://www.kidney.org/atoz/content/nutripd

To increase albumin levels in peritoneal dialysis patients, incorporating high-quality protein foods into the diet is essential. Recommended foods include:

• Lean meats: Turkey or lean beef burgers provide high-quality protein and iron.
• Chicken: Fresh chicken offers significant protein without excess sodium or phosphorus.
• Fish: Options like salmon, mackerel, and rainbow trout are excellent protein sources.
• Eggs: Deviled eggs and egg whites are easy protein-rich snacks.
• Dairy: Greek yogurt and cottage cheese are good protein sources with lower potassium.
• Tofu: A versatile protein alternative for meat, poultry, and fish[3].

Citations:
[1] https://www.jrnjournal.org/article/S1051-2276%2803%2900035-9/fulltext
[2] https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.760394/full
[3] https://www.davita.com/diet-nutrition/articles/advice/15-kidney-friendly-protein-foods-for-keeping-albumin-up
[4] https://go.gale.com/ps/i.do?aty=open-web-entry&id=GALE%7CA123327278&issn=1526744X&it=r&linkaccess=abs&p=AONE&sid=googleScholar&sw=w&userGroupName=anon~e37d0809&v=2.1
[5] https://health.clevelandclinic.org/the-best-diet-for-parkinsons-disease

Since I am on Peritoneal Dialysis, it is of interest to me as I have a background in strategic management to delve into what’s going on in the industry per se. To accomplish this I quizzed Perplexity with the following prompt and results: Prompt: “What’s the latest in research or to market in the world of peritoneal dialysis?”

1. Market Growth and Trends:

• The global peritoneal dialysis market was valued at USD 4.52 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 5.86% from 2022 to 2030, reaching approximately USD 7.13 billion by 2030[1]. The growth is driven by factors such as increasing healthcare expenditure, the rising incidence of renal disorders, and the benefits of peritoneal dialysis over hemodialysis, including lower costs and greater patient mobility[1].
• The Asia Pacific region has emerged as the largest market for peritoneal dialysis, with significant contributions from countries such as China and India[1][5].

1. Technological Advancements:

• Technological advancements in devices, particularly automated peritoneal dialysis (APD), are anticipated to drive market growth. The device sector is expected to expand rapidly due to rising demand for APD[2].
• Baxter International introduced Sharesource Analytics 1.0, an eHealth solution for managing peritoneal dialysis patients at home, which provides comprehensive treatment information to healthcare providers[3].

1. Market Segmentation and Key Players:

• The peritoneal dialysis solution segment currently dominates the market, as solutions are essential for fluid exchange during dialysis[2].
• Key players in the market include Fresenius Medical Care, Baxter International, and Medtronic, among others. These companies are focusing on product launches, innovations, mergers, and partnerships to enhance their market position[2][4].

1. Challenges and Opportunities:

• Despite the growth, challenges such as the lack of skilled professionals, stringent regulatory policies, and technical failures in peritoneal dialysis remain[1].
• Growth opportunities include increasing awareness of chronic kidney disease (CKD), government initiatives, and the development of independent dialysis facilities[2][4].

Overall, the peritoneal dialysis market is experiencing robust growth due to technological advancements and increasing demand for home-based treatments, although it faces challenges related to regulatory and technical issues.

The lead graphic was produced using the FLUX Rev bot of Poe with the Prompt: “Picture of Popeye looking at spreadsheets and charts and pondering the future of the peritoneal dialysis market”

Citations:
[1] https://www.thebrainyinsights.com/report/peritoneal-dialysis-market-13236
[2] https://www.skyquestt.com/report/peritoneal-dialysis-market
[3] https://www.polarismarketresearch.com/industry-analysis/hemodialysis-and-peritoneal-dialysis-market
[4] https://www.grandviewresearch.com/industry-analysis/hemodialysis-peritoneal-dialysis-market
[5] https://www.fortunebusinessinsights.com/industry-reports/peritoneal-dialysis-market-100089
[6] https://finance.yahoo.com/news/global-hemodialysis-peritoneal-dialysis-research-145700826.html?_guc_consent_skip=1721779028
[7] https://www.linkedin.com/pulse/peritoneal-dialysis-market-share-2032-mlmff
[8] https://www.linkedin.com/pulse/peritoneal-dialysis-market-detailed-analysis-current-2welf

My life on peritoneal dialysis continues to roll along nicely. Yesterday was more or less a day off for me. My wife and I traveled to a city about 25 miles north of us named Weatherford, TX to shop for items to put into two thank you basked for the kindness shown to us by our neighbors. One basket is for the couple who helped us lay sod on our former iris bed; the other is for our next-door neighbors who continue to drop off the most delicious food you have ever tasted just because they can. The same second neighbor also informed me that we have a broken sprinkler head along our property line. I checked it out and he’s right. I’ll fix it later today.

Speaking of today, at 0900 I have labs at Fresenius which will take a couple of hours counting travel time. I am not expecting anything out of the ordinary as I explained in the previous blog, my biometrics are currently locked in with good numbers. BTW, my weight this AM was again 141.0, in the grove.

From time to time I cite that I have used Perplexity or Poe to assist in writing this blog. Yesterday I received notification from Poe that they have made available a state-of-the-art bot to make pictures named Flux. There are three versions and two of them are free. I used Flux-dev with the Prompt: “Picture of Popeye eating spinach” for the lead graphic. Pretty cool.

After over a week of being on reduced dwell times for my evening PD treatment, I’m very happy to report that to date, I have felt no indication that it is not working as it should. I feel good when I wake up – earlier now – and more or less put in a full day of outside activities, mostly working in our yard.

Yesterday our two “weeders” arrived as promised and made fast work out of cleaning out our last bed, the one by the single garage. They raked, blew, and took away all the debris, all of this in approaching 100-degree F heat. You got to hand it to the Hispanics in North Texas. They are more than willing to work and can stand the heat that would put a more mortal man on their knees. Out of this bed, we got approximately four 64-gallon plastic bags of stuff that they hauled off.

On another subject, for the last nine days, my morning weight has been 141.0 except for two days when it was 142.0. I suspect on those two days I forgot to do a static drain but did on the others. The point is, I have been using only 1.5% solution and my weight is hanging in there which is what we want.

I haven’t been taking ANY blood pressure medication for a couple of months and these morning readings are also right in there. My readings have ranged from 141/76 to 121/74, with the vast majority in the 120s/70s. I’d say we have a handle on this also. Likewise, my morning, fasting glucose has mostly been in the 90s and 100 to 109 after taking an evening insulin shot of 9 units so I’m very pleased with this also.

The bottom line, at least from a definitive biometric viewpoint, I am hanging in there very well. Hope my readers are also.

Yesterday at 10 AM I visited our local CVS pharm and received my second Shingles shot. So that’s completed. Later in the afternoon I played with their APP and found that I was able to download in PDF format my vaccination records with them dating back to 2014 which I did. I then send this PDF to both my dialysis nurse and GP to bring my records up to date. BTW, I always send my GP our monthly PD lab results also to keep him up-to-date. He is, after all, an important member of my overall health team. We can forget this in our drive to achieve normalcy through dialysis.

Come Thursday I have a lab visit with my temp dialysis nurse. My regular dialysis nurse has August off due to the repair of a rupture. Let’s hope she is doing well.

And if that wasn’t enough, our stock account is down over $20,000 for the day. Enough to make you want to cry in your beer!

I have been promising a video of our yard here in Pecan Plantation, North Texas. I shot the embedded video below on August 1, 2024. If you are attentive, you can see our golden retriever Dickens go gliding by. The yard is my counterlife to being on dialysis. Although it’s very hot at this time of year, if you pace yourself you can still get work done. I post this so my readers can view that there IS a life other than dialysis if you just go for it. Enjoy our yard; I do.

We’ve been cruising alone lately, without much thought to what’s going on in the world of peritoneal dialysis research. To catch up on this topic, I quizzed Perplexity with the following results – interesting to say the least:

• Urgent-Start Peritoneal Dialysis (USPD): Initiation within 14 days of catheter insertion, aimed at providing rapid dialysis access for patients with acute needs[1].
• Patient Selection Criteria: Specific criteria for selecting patients suitable for USPD, considering factors like overall health and urgency of dialysis initiation[1].
• Timing and Data Limitations: Challenges in determining the optimal timing for USPD initiation due to limited data[1].
• Catheter Insertion Techniques: Various techniques for catheter insertion to minimize complications and improve outcomes[1].
• Prescription and Modality Choices: Different peritoneal dialysis prescriptions and modality options tailored to patient needs[1].
• Outcomes and Efficacy: Evaluation of mechanical and infectious complications, survival rates, and healthcare utilization compared to other dialysis modalities[1].
• Barriers and Optimization Strategies: Multidisciplinary approaches, education programs, and clinical pathways to enhance the success of USPD[1].
• Future Research Areas: Identifying gaps in current knowledge and proposing areas for future investigation to improve USPD practices[1].

Citations:
[1] https://www.mdpi.com/2673-8236/4/1/2
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10550002/
[3] https://www.ncbi.nlm.nih.gov/books/NBK532979/
[4] https://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/about/pac-20384725
[5] https://www.kidney.org/patients/peers/dialysis
[6] https://www.kidney.org/kidneydisease/howkidneyswrk
[7] https://journals.sagepub.com/home/ptd
[8] https://ispd.org

I have been on the reduced cycle time for three nights now. I have not experienced a great reduction in my overall time on the cycler. Previously, I had been on two hours per cycler for a total of eight hours dwell time plus fill and drain overhead meant I was spending over eleven hours per night just on the cycler. As I log off the cycler these past three nights, I’m getting times of 10-7, 10-14, and 10-33. These times are NOT the expected one-hour time reduction (15-minute cycler time reduction times four cycles equals one hour.) Seems that my cycler has a mind of its own and also its own math.

Over the weekend my wife and I bought four American Holly trees in two-gallon containers to use as a semi-privacy barrier between us and a neighbor that has a rather junked up side and back yard. Not trashy, but they live kinda inside and outside their house and it shows. On Monday I shopped around and bought all the soil amendments needed. Now I have to dig the humongous holes needed to properly plant them. More fun in the North Texas heat. (See lead graphic.)In case you wondered, we are in growing zone 8. We can expect American Holly to grow 2-4 feet per year, and grow to 20-24 feet tall with a spread of 8-10 feet. We could not tell if we got both male and female plants since there were no labels and both are needed to get the holly berries which birds really like. Time will tell.

I am in the second week of taking meticulous care of our new sod. The first week I watered it 3x per day. This week, the second, we cut back to 2x per day. It is really taking hold and looking healthy, even though we have had several days way in the 90s.

We managed to almost complete weeding the 100-foot-long flower bed in the back. While it looks somewhat bare, that’s 100% better than it looked before. We’re due for mowing Wednesday and I intend on doing a complete walkaround so I can show and articulate to those who visit here what we are working with.